Birth Control Stuck in the Dark Ages

From mood swings to nausea, women accept some side-effects in exchange for reliable, hormone-based birth control, such as the Pill. But that doesn't mean they're happy about it.

A recent study by the non-profit Guttmacher Institute found that half of American women who don't want to be pregnant still aren't reliably using birth control, and even among those who are, four in 10 aren't satisfied with their current method.

Unfortunately, new options may be a long time coming. Owing to a lack of funding and a general resistance to doing truly new research, birth control methods have not changed dramatically in 30 years.

What's available

Making a choice about birth control is all about balancing effectiveness with side effects. There's no single solution that works for everyone, and while hormonal birth control tends to have more side effects, the Food and Drug Administration, as well as numerous research institutions, reports that it is safe. Even the Ortho-Evra patch, recently linked to increased risk of pulmonary embolism (clots that block blood flow to the lungs), is safer than you might think.

That's something Dr. Jill Schwartz wanted to make clear. Schwartz is a clinical research manager with CONRAD, a non-profit contraception and HIV prevention institute, based at the Eastern Virginia Medical School. She said that while there is a greater risk of embolism with the Patch than with the Pill, pregnancy itself is still more of an embolism risk than either form of birth control.

Simply being safe, however, doesn't mean that a product is going to be well-liked. And there aren't a lot of options for women who dislike hormonal birth control but want the same high level of effectiveness. In fact, out of all the non-hormonal contraceptives currently available, the FDA reports that only two, sterilization and intrauterine devices or IUDs, have failure rates comparable to hormonal methods.

"There does seem to be a lack of research from the public and private sector on new methods," said Jennifer Rogers, director of programs and policy for the non-profit Reproductive Health Technologies Project in Washington, D.C.

The research gap

Between 1996 and 2004, the sciences in general made big advancements, but birth control research failed to keep up, according to a 2004 paper published by the Board of Health Sciences Policy at the government-created non-profit Institute of Medicine in Washington, D.C.

Instead, the paper's authors stated, most of the contraceptives created or introduced during that time were based on technology that already existed. Worse, new researchers weren't coming on board to replace aging contraception scientists and, unlike many scientific fields, there was no centralized research organization or information clearinghouse dedicated to contraception.

So why is this field falling behind? Mostly, it's money. The Board of Health Sciences Policy said birth control research doesn't get enough funding to support long-term studies or attract young scientists with new ideas. Other experts say research into completely new types of birth control tends to come from public funding, and that's been slipping. For instance, the budget for the Contraceptive and Reproductive Health Branch of National Institute of Child Health and Human Development was cut from $50 million in 2004 to $35 million in 2007.

That means fewer completely new options for women. However, there have been improvements to existing products, such as pills that limit periods to four times a year. That's because drug companies tend to focus on improving, refining, and repackaging current contraceptive technologies, research which gets faster results for less cash.

New and improved

So what progress has been made? Plenty, if you're looking at the improvements.

Thirty years ago, our mothers and grandmothers took birth control pills with doses of the hormone estrogren 20 times higher than what we take today. As a result, they had higher rates of side effects. That's no longer the case. In fact, Dr. Sheldon Segal of the Population Council, a non-profit research institution based in New York, said that much of today's research is aimed at lowering those doses even further by administering hormones in new ways, such as via sprays.

Another promising option is an improved diaphragm, named SILCS. Diaphragms are unpopular and women who do own them frequently fail to use them because they're difficult to insert. SILCS' design is based on feedback from real women. It's one-size-fits-most, making it easier to purchase, while changes to contour and gripping surfaces make it easier to put in and more comfortable, so it's more likely women will actually use it. Dr. Schwartz at CONRAD said SILCS could hit stores by 2010.

However, truly alternative methods are much further away from completion. Some of the things to anticipate down the line: Non-hormonal vaginal rings, which would release drugs that immobilize sperm or block hormone function in the ovaries, and male birth control, both hormonal and not.